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In the midst of this measles outbreak, everyone has started talking about extreme anti-vaccine advocates (such as that crazy cardiologist in Arizona who I'm not going to give free publicity to) or politicians stepping into it about "freedom of choice" (see Chris Christie's and Rand Paul's recent statements). But extremists and pandering politicians are distractions from the kind of doctor that more and more healthcare providers are concerned about: vocal anti-vaccine friendly doctors who believe themselves to provide an attractive "middle ground" to parents worried about vaccines. But instead of offering parents reassurance with accurate information about vaccines' benefits and risks, they provide misleading information, encourage delaying vaccines and openly welcome parents who don't want to vaccinate at all.

The most famous and vocal of these doctors, who have built their reputations on this play-both-sides strategy, are Dr. Bob Sears and Dr. Jay Gordon.

"Drs. Gordon and Sears – the profiteering, publicity-seeking 'celebrity' pediatricians they are – completely disregard the CDC-recommended vaccination schedule and instead give their unfounded blessings to thousands upon thousands of parents to not vaccinate at all," said Chris Hickie, an Arizona pediatrician who has tracked both doctors' exploits on his website.

What irks Hickie, and an increasing number of other healthcare providers, is that both Sears and Gordon are not only board-certified medical doctors but also members of the American Academy of Pediatrics (AAP) who carry the designation FAAP, or "Fellow of the American Academy of Pediatrics." According to the AAP, earning the FAAP title requires physicians to complete accredited medical training with a pediatric residency that then qualifies them to sit for the American Board of Pediatrics exam or an international equivalent. (A separate pathway exists for physicians in other specialties who spent at least half their professional time caring for children.) They must also be current AAP members (which includes paying annual dues).

"I cannot understand why the AAP allows Sears and Gordon to be AAP fellows given how their very public and profit-driven views are contrary to AAP immunization policy," Hickie said. "The AAP urgently needs to come out vocally against all anti-vaccine groups. The AAP's lack of concern toward two of their own pediatricians who openly endanger all children is dead wrong and casts serious doubt as to how dedicated the AAP is 'to the health of all children,'" which refers to the AAP's motto.

According to the AAP by-laws, "The Board of Directors may terminate a member for good cause," defined as consisting "of any conduct by the member that is seriously prejudicial to the interests of the Academy or of the Chapter, or the loss of one or more qualifications for membership in the Chapter." When I asked AAP what might qualify, the organization informed me in a statement that the AAP may "suspend or end of the membership of a member due to other circumstances [other than a lapse or resignation of membership], such as being convicted of a crime, engaging in improper financial dealings or for gross medical incompetence." The rare cases in which FAAP status has been revoked in this way, the organization said, were "directly related to a member being convicted by a court of law for a felony or crime, or having lost their license to practice by formal action of a state medical board or licensing body."

For many doctors, the actions of Sears and Gordon should qualify, however.

"As physicians, they're entitled to their opinions," Roy Benaroch, MD, FAAP, a pediatrician and blogger who wrote a scathing recent post about Sears, told me. "But endangering the public health by encouraging non-vaccination makes them a menace to their communities, and they're not following the principles of good pediatric care. At the very least, their state medical boards ought to rebuke them for practicing bad medicine, and the AAP ought to come out with a strong statement that what they're saying is factually wrong and is hurting children and communities. I believe it would also be appropriate for the AAP to consider revoking their status as Fellows of the AAP."

Both Dr. Bob Sears and Dr. Jay Gordon have authored books. Information in Sears' book deviates from AAP policy statements and the CDC vaccination schedule. photo by Tara Haelle

Gordon, the pediatrician who treated Jenny McCarthy's son, promotes a DVD about vaccines and says he doesn't recommend the MMR (measles-mumps-rubella) vaccine before age 3. "I have not personally seen an adverse reaction to an MMR vaccine, but I have sat with and spoken to many parents who are certain that their child was adversely affected," Gordon told me by email. "My reason for delaying the MMR is that it might adversely affect development in a small percentage of children. It might also mistakenly be thought to be the cause of problems in other children leading to diminished credibility in a doctor's office."

Gordon told me regarding the current outbreak that "virtually all" of his patients have had questions, "but they also realize that 100 cases in a population of 38,000,000 Californians does not pose a statistical risk to their families," a statement which neglects the fact that measles infects 90 percent of susceptible individuals it meets and therefore travels quickly through a population. "I think this measles outbreak could become quite a bit larger and the AAP's recommendation [encouraging measles vaccination] may help to prevent this," he said, adding that many of his patients are choosing to vaccinate and that he's given at least 100 MMR vaccines in the past few weeks. Yet giving a 100 measles vaccines cannot undo a long history of courting anti-vaccine views. A previous letter Gordon wrote stated that unvaccinated children are "healthier in general" and again suggested falsely that vaccines are linked to autism. Aside from public appearances with Jenny McCarthy and speaking at anti-vaccine rallies, Gordon's anti-vaccine activities are highlighted here, here, here, here and here.

Sears presents an even more problematic case, particularly because of the influence of his vaccine schedule and his family.

"Bob Sears is a man with no published expertise with vaccines, who has never done research on vaccines and never been a part of a data safety monitoring board, who has collected vaccine inserts in his office and makes up a schedule – what hubris this man has," said Paul Offit, director of the Vaccine Education Center and a professor of pediatrics in the Division of Infectious Diseases at The Children's Hospital of Philadelphia. Offit also co-published a thorough rebuttal describing the flaws in Sears' schedule in Pediatrics, the official publication of the AAP. "He's clever using the word alternative because it's enticing – alternative energy, alternative music – and makes it sound like this is a different way to do the same thing, but by delaying vaccines, all he's doing is increasing the period of time during which children are susceptible to vaccine-preventable diseases."

Sears' schedule also sows uncertainty in parents' minds, Benaroch said. "His 'alternative schedule' suggests there is controversy in the medical community when in fact there is not," he said. "It suggests somehow that he is more learned or wise or knowledgeable than the experts worldwide who make vaccine recommendations, and he is not."

The CDC vaccine schedule requires extensive testing and evidence that a vaccine does not interfere with the safety or effectiveness of any other vaccine on the schedule, and vice versa. It is developed by a group of experts, the Advisory Committee on Immunization Practices (ACIP), with extensive backgrounds in vaccine research, immunology and other fields who meet regularly to review the schedule.

By contrast, Sears relied on nothing but his own clinical experience to create his schedule. "I will note that there is no evidence that going more slowly [with vaccines] is safer, and I have never claimed such," he told me by email about his schedule.

Yet Sears has another ace in his pocket that gives his invented schedule more heft: being a member of a family that has long been famous for its books and parenting advice. "That his schedules come from a 'Sears-family' pediatrician makes it all but impossible for a non-celebrity pediatrician to counter his schedule," said Hickie, who has had 50 to 100 parents come to his clinic citing the schedule since 2007, when Sears' book was first published.

Sears says that his book "allows people who would otherwise not have vaccinated to go ahead and get vaccines in a way they are more comfortable with and to guide people who are trying to pick and choose which vaccines are most important for their child," but evidence has shown his book may have actually encouraged families who otherwise would have followed the CDC schedule to deviate from it. A study in 2011 found that more than 10 percent of parents use an "alternative" schedule, and "a large proportion of alternative vaccinators (30%) reported having initially followed the recommended vaccination schedule." Further, "a large proportion of parents currently following the recommended schedule seem to be 'at risk' for switching to an alternative schedule." The term "alternative vaccine schedule" didn't even register in Google trends until just after Sears' book's publication, when mention jumped out of nowhere.

This screenshot of Google Trends for the key words "alternative vaccine schedule" show that the term only appeared measurably in Google after Sears' book was published in 2007.

"It puts kids at unnecessary risk without any benefit. I don't understand why a pediatrician would promote a schedule that increases the chance that a child could be harmed by a preventable disease unless he really doesn't understand the diseases or the vaccines," said Nathan Boonstra, MD, FAAP, a pediatrician at Blank Children's Hospital in Des Moines, Iowa, who blogs for their site. He said it's possible that parents who otherwise would not have vaccinated might be convinced by Sears schedule, "but those few are overshadowed by those that start to unnecessarily fear vaccines because of misleading information in the book," something Boonstra has seen in his own clinic. "Parents think they are making a better decision by following his plan instead of the recommended one. Instead, though they have the best intentions, they are putting their child at greater risk."

But it's not just Sears' schedule that frustrates his colleagues. It's his repeated, potentially unethical public dismissal of the seriousness of measles and other diseases. When the Disneyland outbreak was in its early stages in January, Sears posted to his Facebook page that encephalitis is "extremely rare in well-nourished people" (it's about 1 in 1,000), that the complication of pneumonia is "treatable" (previously healthy individuals can die from pneumonia while receiving treatment), and that the risk of death from measles in the U.S. is "as close to zero as you can get without actually being zero" (123 people died from measles during the 1989-91 U.S. outbreak). "If you understand measles, you wouldn't fear it," he said.

Yet Offit, who not only understands measles but watched children die in Philadelphia during that outbreak 25 years ago, said measles is a disease to fear. "Measles is a potentially fatal infection, and it can happen to anyone. The children who died in Philadelphia were perfectly well nourished," Offit said. "Go through an epidemic and you have a healthy respect for this virus."

Sears became frustrated with responses to his post and penned another sarcastic one calling people "stupid" for criticizing his post's omission of any mention of the measles vaccine. But even now, with cases in California approaching 100 – almost one sixth of all measles cases in the U.S. in 2014 – Sears expressed little concern to me about the outbreak locally: "Here in Orange County, where I practice, the outbreak is still small, no bigger than what occurred here last year, at least so far," he said. "It may spread a bit more, but it won't reach high numbers in a population where most are vaccinated." Yet about half Sears' own patients "forgo vaccines altogether" – a proportion that would virtually assure a large-scale epidemic if other communities had similar numbers.

"When 30 percent of children are hospitalized for measles, I am not sure why a healthcare provider in California would say measles is 'not a serious infection,'" Ari Brown, MD, FAAP, an Austin, Texas, pediatrician and author of Baby 411, told me. "When one of his own patients dies from measles, I suspect he will change his mind, but I hope it does not take that tragedy to demonstrate to the rest of us that prevention is the best action to protect our kids."

Sears does not deny that a death might occur. He doesn't deny that vaccines work, that measles is "virtually preventable with the MMR vaccine," that "those too young to be vaccinated" or immunocompromised are at risk of catching the disease if exposed to a sick, unvaccinated individual, and that "it's especially tragic when it results in a fatality or permanent disability," all of which he wrote in a lengthy Facebook post he encouraged me to quote from. The post attempts to clarify why he thinks we need "to stop and listen to each other," which certainly sounds reasonable and few would argue with. But here's what he also says: "Which right is more important, the right to not get sick with a disease or the right to make health care decisions for yourself and your child? The way I see it, the diseases were here first. Because we have invented a medical treatment to try to change the status quo, yet that treatment can cause harm to a very small percentage of people, it is my belief that we shouldn't force anyone into accepting this treatment. Life happens, death happens."

That "harm to a very small percentage of people" from the MMR vaccine, however, means fever, rash, swelling or joint stiffness in some people, one fever-caused seizure with no long-term effects in 3,000 people, one case of low platelets count that usually resolves on its own in 30,000 people, and a potential allergic reaction in 1 in a million. The CDC notes that other seizures, deafness and brain damage following the MMR vaccine are so rare (i.e., less than 1 in a million) that it's difficult to know whether the vaccine was related.

"While acknowledging that measles can be especially serious for babies and the immunocompromised, Dr. Sears didn't seem to think considering their safety was important," Benaroch said. "He seemed to say, basically, that parents don't need to worry about the effect of measles on their children, anyone else or on public health."

And though Sears claimed in that post that "pro-vaccine" advocates rarely acknowledge vaccine risks, Boonstra, the Iowa pediatrician, who also serves patients that don't vaccinate, said he agrees "it's very important to talk with parents about how even a vaccine has a tiny risk, but not to misrepresent the risk, which is what I find Sears does."

So given Sears' and Gordon's words and actions, should the AAP take action? The organization has already strongly recommended the measles vaccine in the wake of the current outbreak and issued another statement yesterday reiterating the seriousness of measles, the safety and effectiveness of the vaccine and that "delaying your child's vaccines, or refusing the vaccine, leaves your child vulnerable to this invisible threat and puts other children in the community at risk." In their statement to me, they stated that "opting for an 'alternative schedule' falls into the category of delayed vaccinations, which puts our youngest, most vulnerable children at risk for serious and sometimes deadly infections."

They also provided this statement when I asked directly about Sears and Gordon: "The AAP greatly values the diversity of opinion and perspective that exists within its membership and upholds the right of all members to question or disagree with its policies or positions. The AAP also reserves the right to speak out strongly on evidence-based policy and note when its members are denying or ignoring best science." Indeed, in a message sent directly to AAP members yesterday, AAP President Sandra G. Hassink said, "Advocacy of delayed or alternative immunization schedules increases the risks to all children. The AAP strongly urges all members to follow the approved immunization schedule and to help educate families about the safety and effectiveness of childhood vaccines."

But that's what frustrates the AAP members I spoke to – the organization has not directly addressed comments by Sears or Gordon by name.

"I think that if they use not only their MD but also their FAAP as a platform to stand on and provide misinformation that leads people to make bad decisions, that's the opposite of what the AAP stands for, so I think the AAP should, in some form censure both of them," Offit said. Both Sears and Gordon promote their FAAP status: it's on the cover of Sears' book and in Gordon's Twitter handle. "I think the AAP has to take that seriously and should make it clear that both Bob Sears and Jay Gordon are providing information that goes against the data and is incorrect," Offit said.

Hickie would take it further: "What would you think of a pulmonologist who told his/her patients it is safe and ok to smoke? What would you think of a dentist who told patients they don't have to brush and floss their teeth? What would you think of an obstetrician who told expecting moms they can drink alcohol while pregnant? This tolerance by the AAP of these two anti-vaccine pediatricians is so disturbingly contrary to one of the most important things we do as pediatricians for children and public health – vaccination to prevent the spread of diseases with high morbidity and mortality. I do think Sears and Gordon should be publicly expelled from the AAP for their anti-vaccine views and actions."

Sears, for his part, told me, "Many bloggers, tweeters and minor reporters have incorrectly characterized my open-minded position as anti-vaccine when, in fact, my book states very clearly that children should get an MMR vaccine at age 1 and age 5. Yet, because I'm willing to disclose what the possible side effects of the vaccine are and because I am one of the waning number of pediatricians who are still willing to care for unvaccinated families, I am incorrectly labeled anti-vaccine."

Perhaps one could argue that Sears himself, and Gordon, cannot fairly be labeled truly "anti-vaccine" if they give vaccinations in their practices. But here's the thing: I met and interviewed Sears several years ago, when I first started reporting on vaccines and wanted to explore every avenue, including that of the anti-vaccine side. And so I met Sears at the Dallas Film Festival screening of the anti-vaccine movie The Greater Good. He was serving on a panel there with anti-vaccine doctor Lawrence Pavlevsky, anti-vaccine Texas advocate Dawn Richardson, and anti-vaccine NVIC founderBarbara Loe Fisher. And Gordon has regularly spoken publicly with Jenny McCarthy, anti-vaccine celebrity extraordinaire. From my perspective, the company you keep says a lot about you and your beliefs. Perhaps that's what fellow AAP members are so concerned about.